Table 4.

Consequences of the antiretroviral (ARV) drug–co-prescribed drug interactions in HIV-infected children and the alternative drugs to use

ARV and co-prescribed drug interaction	Potential clinical effects of the interaction	Alternative drug and/or remark
Nevirapine + artemether/lumefantrine	Decreased extent and rate of absorption of nevirapine and artemether/lumefantrine.28 Potentially increased treatment failure.28	Quinine, but may require clinical and laboratory monitoring of the patient.25
Nevirapine + fluconazole	Increased rate and extent of absorption of nevirapine.28 Decreased half-life of nevirapine, resulting in increased effects.28 Potentially increased nevirapine effects.28	Dosage adjustment of nevirapine or fluconazole is unnecessary; clinical and laboratory monitoring of the patient is required.28
Zidovudine + fluconazole	Zidovudine half-life is increased, resulting in increased effects.28	Ketoconazole.25
Zidovudine + rifampicin	Decreased extent of absorption of zidovudine.26	Rifabutin.28
Nevirapine + prednisolone	Pyrexia and vomiting.29	Dosage adjustment of nevirapine or prednisolone is unnecessary; clinical and laboratory monitoring of the patient is required.30
Zidovudine + ibuprofen	Altered bleeding time reported in a patient.30	Paracetamol or tramadol.25
Efavirenz + rifampicin	Decreased extent and rate of absorption of efavirenz.28 Decreased efavirenz effects.28	Rifabutin.25
Zidovudine + clarithromycin	Decreased rate and extent of absorption of zidovudine.25 Decreased plasma level of zidovudine.25	Azithromycin.25
Nevirapine + clarithromycin	Decreased rate and extent of absorption of nevirapine.28 Increased blood level of clarithromycin.28	Azithromycin.25
Lamivudine + frusemide	Frusemide is a potential substrate and inhibitor of the renal transporters involved in lamivudine elimination.25	Dosage adjustment of lamivudine or frusemide is unnecessary in patients with normal renal function, but clinical monitoring may be required.28
Nevirapine + frusemide	Nevirapine may potentially interfere with the enzymes involved in the renal elimination of frusemide.25	Dosage adjustment of nevirapine or frusemide is unnecessary in patients with normal renal function, but clinical monitoring may be required.28
Abacavir + metronidazole	Plasma level of abacavir may be increased.25	Dosage adjustment of abacavir or metronidazole is unnecessary. Clinical and laboratory monitoring of the patient may be required.25
Lopinavir/ritonavir + artemisinin-based combination therapy	Ritonavir may increase the plasma levels of artemisinins.25	Dosage adjustment of lopinavir/ritonavir or artemisinins is unnecessary. Clinical and laboratory monitoring ofthe patient may be required.25
Efavirenz + loratadine	Efavirenz may increase the conversion of loratadine to the active metabolite.25	Cetirizine, chlorphenamine, and promethazine.25 Fexofenadine.28
Efavirenz + artemisinin-based combination therapy	Decreased artemether, dihydroartemisinin, and lumefantrine exposures.25	Quinine, but its exposure could be decreased.25 Dosage adjustment of quinine or efavirenz is unnecessary. Clinical and laboratory monitoring of the patient may be required.25
Nevirapine + rifampicin	Decreased rate and extent of absorption of nevirapine.28 Decreased half-life of nevirapine.28 Potentially decreased nevirapine effects.28	Rifabutin.28
Lamivudine + sulfadoxine/pyrimethamine	Potentially decreased lamivudine renal elimination as in vitro data suggest that pyrimethamine inhibits the renal transporters involved in lamivudine elimination.25	Proguanil.25 Dosage adjustment of sulfadoxine/pyrimethamine is unnecessary in patients with normal renal function, but clinical monitoring of the patient is required.25
Lopinavir/ritonavir + artemisinin/amodiaquine	Ritonavir may increase plasma levels of artemisinins.25 Lopinavir/ritonavir could potentially increase amodiaquine exposure.25	Dosage adjustment of either drugs is unnecessary.25 Close monitoring for artemisinin toxicity and amodiaquine-related adverse effects are required.25
Efavirenz + artemisinin/amodiaquine	Decreased artemether and dihydroartemisinin exposures.25 Increased amodiaquine exposures.25	Quinine, but its exposure could be decreased.25 Dosage adjustment of quinine or efavirenz is unnecessary. Clinical and laboratory monitoring of the patient may be required.25
Efavirenz + clarithromycin	Decreased clarithromycin exposure and effects.25,28 Increased absorption rate of efavirenz.25,28	Azithromycin.25,28
Nevirapine + ketoconazole	Decreased rate and extent of absorption of ketoconazole.28 Potentially decreased ketoconazole effects and increased nevirapine effect.28	Efavirenz with fluconazole.25
Lopinavir/ritonavir + proguanil	Decreases the extent of absorption of proguanil.28 Potentially compromises antimalarial activity of proguanil.28	ZPyrimethamine.25
Lopinavir/ritonavir (solution) + metronidazole	Disulfiram reaction (hypotension, headache, nausea, vomiting) due to the alcohol content of the lopinavir/ritonavir solution.28	Lopinavir/ritonavir capsule.28
Lopinavir/ritonavir + loratadine	May increase loratadine plasma levels, resulting in increased loratadine effects.25	Cetirizine or chlorphenamine.25 Fexofenadine.28
Lopinavir/ritonavir + frusemide	Lopinavir/ritonavir may potentially interfere with the enzymes involved in the renal elimination of frusemide.25	Dosage adjustment of lopinavir/ritonavir or frusemide is unnecessary in patients with normal renal function but clinical monitoring may be required.25
Lopinavir/ritonavir + prednisolone	Increases the extent of absorption of prednisolone.28 Possibly increased prednisolone effects.28	Dose adjustment of lopinavir/ritonavir or prednisolone unnecessary.28